Pancreatic cancer therapy: focus on the systemic treatment

Pancreatic cancer therapy

Accessibility of the novel and updated conventional treatment techniques in Germany allows providing each oncologic patient with the highest chance of the disease defeating. There is no doubt that surgery in pancreatic cancer is crucial for improving long-term survival.

Accessibility of the novel and updated conventional treatment techniques in Germany allows providing each oncologic patient with the highest chance of the disease defeating. There is no doubt that surgery in pancreatic cancer is crucial for improving long-term survival. However, during the surgical procedure, a doctor typically removes only the primary tumor, not reaching distant metastases. Novel clinical trials have demonstrated that the combination of chemotherapy is efficient in the prevention of postoperative malignant cells spreading. Moreover, innovative targeted medications are able to attack specifically the unique features of cancer cells and spare the healthy ones.

When you should suspect developing pancreatic cancer

Pancreatic cancer symptoms primarily depend on the tumor type. Over 93% of all pancreatic neoplasms are adenocarcinomas. This means that they arise from the exocrine part of the pancreas and do not produce hormones. Early adenocarcinomas are asymptomatic, and even the advanced ones do not have any specific manifestations. However, there are few signs that should increase the oncological alertness:

  • Pain with localization in the upper abdomen or back.
  • Jaundice (yellow color of eyes and skin) that may be attended by skin itching and darkening of urine.
  • Loss of appetite that causes weight loss.
  • Indigestion signs, including nausea and vomiting.
  • Stool changes, pale or grey and fatty stool.

The islet-cell or neuroendocrine tumors are diagnosed in up to 7% of all pancreatic neoplasms. The specific feature of such formations is the ability to produce hormones. Depending on the hormonal activity, insulinomas, gastrinomas, glucagonomas, VIPomas, and gastrinomas are distinguished. Neuroendocrine tumors reveal themselves with additional specific signs, like the newly onset diabetes mellitus or decompensation of the previously diagnosed diabetes, diarrhea, muscle spasms, etc.

Tests for the diagnosis validation

Pancreatic cancer diagnosis in Germany is primarily based upon a physical examination. A general practitioner examines abdomen of a patient, checks his eyes and skin for signs of jaundice. If a doctor suspects pancreatic cancer, he recommends furthermore extensive investigation:

  • Ultrasound examination, including the endoscopic ultrasound.
  • Endoscopic retrograde cholangiopancreatography which is another endoscopic procedure with injecting special, visible for X-rays, dye into pancreatic and bile ducts. Further X-ray examination highlights pathological formations is this region.
  • Magnetic resonance cholangiopancreatography uses magnetic fields for the same purpose.
  • MRI or CT scan, PET or PET-CT scan are used for the comprehensive assessment of abdomen or the whole body. These procedures are mainly used when the tumor metastasizing is suspected.
  • Laparoscopy is a surgical intervention that allows the direct assessment of abdominal organs. It is performed via tiny skin incisions, with the help of a flexible tube with a microscope, camera and light source.
  • Biopsy is harvesting tissue samples from the suspicious region of the pancreas or a nearby organ. It may be performed during endoscopic procedures or open surgery, as the additional diagnostic measure.

Unfortunately, there are no efficient screening tests for malignant pancreatic neoplasms. Surveillance programs are under development yet. Most probably, screening tests will include the search for specific biomarkers in blood or pancreatic fluids.

Novel therapeutic approaches

Conventional treatment scheme includes surgical intervention along with radiation therapy and chemotherapy. Depending on the disease stage, such surgical interventions as Whipple procedure, distal or total pancreatectomy are used. Chemotherapy with gemcitabine and radiation therapy are used before or after the surgery in order to facilitate the procedure and enhance its effect.

In 2018, the new chemotherapeutic regimen mFOLFIRINOX has been elaborated. It includes a combination of oxaliplatin, leucovorin, irinotecan, and 5-fluorouracil. The mFOLFIRINOX has demonstrated effectiveness in patients with metastatic cancer.

Targeted drugs recognize unique molecules on the cancer cells or in their environment. Three regimens of targeted therapy are approved for clinical use in Germany. These are erlotinib for patients with advanced cancer, sunitinib and everolimus for patients with neuroendocrine tumors, and larotrectinib for patients with changes in the NTRK gene.

In addition, scientists from Albert Einstein College of Medicine have published the results of experiments using bacteria for carrying radioisotopes directly into the pancreas. The incidence of secondary tumors in the experiment went down significantly. The tumor was less likely to metastasize, compared with other therapeutic options, and there was little harm to healthy tissues.

Booking Health arranges treatment abroad

A patient may want to undergo treatment of pancreatic cancer in Germany for different reasons. Anyway, in a lack of previous international experience, it will be better to contact Booking Health. Booking Health is an international medical tourism provider that has special system of work with German clinics. Qualified specialists of Booking Health assist a patient and his relatives in:

  • Making choice between the best centers with specialization in pancreatic cancer therapy.
  • Making an appointment for outpatient or inpatient medical program.
  • Elaborating the basic diagnostic or therapeutic program.
  • Translating the results of previous examinations into German in order to avoid their repetition.
  • Taking care of the administrative documents, visa issuing.
  • External monitoring of the program by our independent experts.
  • Communication with the physician after returning home, arrangement of distant consultations, if necessary.
  • Avoiding overpricing (saving up to 50%) and double-checking the final calculation.
  • Taking care of accommodation and tickets, transfer.
  • Arranging services of personal medical coordinator and interpreter.

Booking Health offers all-inclusive support 24/7 and takes overall organizational issues.


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